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Biomedical subjects

G E Rose

Publications and source records attributed to G E Rose.

At least 19 recordsLinked to original sources
PubMed2006

Lacrimal drainage surgery in patients with rare nasal diseases.

AIM: To examine the results of open lacrimal drainage surgery in patients with rare nasal diseases. METHOD: A retrospective review of a group of patients with rare nasal disease who underwent open lacrimal surgery over a 15-year period at Moorfields Eye Hospital. Three main groups of disease were identified: (I) patients with treated mid-face tumours; (II) patients with prior major midfacial injury or surgery; and (III) patients with congenital nasal anomalies, including nasal aplasia. The more common systemic conditions of Wegener's granulomatosis and sarcoidosis were specifically excluded. RESULTS: Eighty-six patients (43 men; 50%) were identified with an age range between 1 and 82 years at the time of surgery. A total of 100 primary procedures were performed in 85 patients and symptomatic relief was achieved in 83/100 (83%) eyes, with 18/100 eyes (18%) requiring two or more lacrimal procedures. Lacrimal reconstructive surgery was considered impractical in two further patients. There were no intraoperative and few postoperative complications. CONCLUSION: With adequate experience, open lacrimal surgery appears to be a safe and effective procedure in the majority of patients with rare nasal diseases or major nasofacial anomalies.

Adolescent↗
PubMed2006

Postural visual obscurations in patients with inactive thyroid eye disease; a variant of 'hydraulic' disease.

AIM: This investigation newly describes the characteristics and treatment for a group of patients with inactive thyroid eye disease who presented with recurrent transient visual obscuration, generally related to sudden changes in posture. STUDY DESIGN: A retrospective case-note review of an unmatched case series. PATIENTS AND METHODS: Clinical records were reviewed for patients with thyroid eye disease, presenting to the Orbital Clinic at Moorfields Eye Hospital with recurrent transient visual obscuration. All patients underwent orbital decompression and the response to this, and other, treatment was reviewed. RESULTS: Six patients (five female) presented to the Orbital Clinic, between the ages of 43 and 66 years (mean 54.7; median 52 years), with recurrent visual obscurations related to postural changes. Transient obscurations had been noted for between 3 weeks and 2 months, the patients having had symptoms of underlying thyroid eye disease for between 6 and 18 months. Five patients had diabetes for between 2 and 45 years, four being controlled with insulin and one with metformin. All patients had increased orbital tension on clinical assessment, intraocular pressures were raised in 5/6, and the optic disc in affected eyes was markedly swollen (with bilateral choroidal folds in two patients). Hertel exophthalmometry ranged from 22 to 27 mm, and there was a global reduction in ocular ductions in all. Bilateral orbital decompression was performed in all patients, although sequentially in one patient: 4/6 patients had three-wall decompression with an average proptosis reduction of 5.8 mm (range 2-8 mm; eight orbits) and 2/6 had decompression of the medial wall and floor alone (mean reduction 6.8 mm, range 5-8 mm; four orbits). In all patients, there was an almost immediate cessation of obscurations, together with a subjective and objective improvement in various visual functions. Optic disc swelling resolved over a few weeks after surgery. CONCLUSION: The 'hydraulic' variant of thyroid eye disease-characterised by high orbital apex pressures, with secondarily raised episcleral venous and intraocular pressures-may be linked with certain orbital shapes, such as that of Asians. This variant can present with recurrent visual obscuration associated with transient postural hypotension, especially in diabetics-this possibly being due to a microvasculopathy of the orbital or optic nerve circulation.

Adult↗
PubMed2006

Endoscopic transnasal orbital decompression for visual failure due to sphenoid wing meningioma.

AIM: To review a group of patients with sphenoid wing meningioma and visual impairment. The technique and results for endoscopic transnasal decompression of the orbital apex is presented. PATIENTS AND METHODS: Patients presenting between 1993 and 2004 with visual impairment due to sphenoid wing meningioma were identified. All patients had full ophthalmic assessment, automated visual field testing, and appropriate orbital imaging. Patients with clinical evidence of significant progression in visual impairment (loss of acuity, reduced colour discrimination, or field deterioration) underwent endoscopic transnasal orbital decompression. OUTCOME MEASURES: Assessment of visual function (Snellen acuity, Ishihara colour perception, and visual field testing), together with other measures of orbital structure and function (ocular balance, ductions, and exophthalmometry). RESULTS: Twelve patients (all women) presented to the Orbital Clinic between the ages of 38 and 71 years (mean 42.6; median 48.5 years) and with symptoms for an average of 32 months (3-102 months; median 22). The most common symptom was swelling and proptosis, in 11 (91%) patients, and subjective deterioration of vision had been noted in six cases (50%). Eight right orbits (67%) were affected and the preoperative acuity varied between Snellen 6/5 and counting fingers, with visual field impairment in all cases. There was an average of 5.0 mm of axial proptosis (range 5-9 mm; median 5). Endoscopic decompression was without complication in all cases. With a follow-up interval of 33.9 months (range 5-80; median 26 months), there was a subjective and objective improvement in visual functions-with Snellen acuity improving between 1 and 4 lines in seven patients, reduction in relative afferent pupillary defect in 10/12 patients, and improved visual field testing. There was a 2.3 mm reduction in proptosis (1-4 mm; median 3 mm) with less lid swelling, improved ocular balance and motility in four patients, and slightly worse diplopia in one patient. Three patients required further procedures: one had ipsilateral middle meatal antrostomy for retained secretions at 18 months and two had strabismus surgery. Three patients underwent fractionated radiotherapy for large tumours, or for late tumour growth and recurrent visual impairment. CONCLUSION: Orbital decompression by transnasal endoscopic ethmoidectomy appears to alleviate optic nerve compression due to sphenoid wing meningioma, with a reasonable relief of the condition for some years. Some patients will require later radiotherapy for progressive tumour growth or visual failure.

Adult↗
PubMed2006

Natural history of periocular capillary haemangiomas: changes in internal blood velocity and lesion volume.

AIM: Although the clinical characteristics of childhood periocular capillary haemangiomas are well known, serial measurements of blood velocity and lesion size are unknown. This investigation was designed to measure the changes in maximum blood velocity and estimated size of lesion in children with capillary haemangioma not requiring active intervention. STUDY DESIGN: Retrospective case-note review for a cohort of children with capillary haemangioma involving the eyelid and orbit. PATIENTS AND METHODS: Children with periocular capillary haemangioma, under the care of the Orbital unit at Moorfields Eye Hospital between 1996 and 2005, were monitored clinically and with repeated ultrasonographic examination. Volume estimates were calculated as an ovoid based on the three maximum orthogonal measurements for the haemangioma, and blood velocity was assessed by Colour Flow Mapping, Colour Doppler Energy Imaging, and Spectral Doppler techniques using a Sequoia 512 Acuson scanner. RESULTS: Twenty-four children (12 boys) had initial assessment by 18 months of age, and the haemangioma increased in size in 14/24 (58%), the increase being between 4 and 931% of initial volume estimate. The largest measured size for an individual haemangioma appears inversely related to the child's age at measurement, this mirroring a similar trend in measurements for the maximum blood velocity. Blood velocity measurements also tend to decrease with time, the peak velocity being before 1 year of age in the majority (15/24; 62%). In many children, both volume estimates and blood velocities show a cyclic variation-this occurring with increasing intervals between the maxima, before a final decay in both parameters. Although, for the whole group, there was no correlation (correlation coefficient=0.29) between estimated size and measured blood velocity, some individual children showed a significant correlation between the two parameters. The age at maximum blood velocity appeared to precede the age at maximum volume in most children, and in many there was an orbital anomaly detectable on ultrasonographic examination, even with complete clinical resolution of the haemangioma. CONCLUSIONS: Ultrasonographic examination of periocular capillary haemangiomas show that these lesions have a very high blood velocity in feeding vessels-about 2-3 orders of magnitude greater than normal capillary beds-and that the velocity and volume of such lesions undergo a cyclic variation during their natural history. Evidence suggests that both velocity and volume decrease with time, although often not returning to zero on ultrasonography (unlike the clinical resolution of the lesions). In most children, blood velocity peaks before volume estimates and this might suggest that decreasing perfusion leads to later tissue atrophy and involution of the haemangioma.

Blood Flow Velocity↗
PubMed2005

Thyroid orbitopathy possibly predisposes to late-onset of periocular lymphoma.

AIM: The prevalence of thyroid orbitopathy, compared with an estimate for the United Kingdom population, is examined in a large cohort of patients treated for periocular lymphoma. PATIENTS AND METHODS: Clinical details were reviewed for patients presenting to the Orbital Clinic at Moorfields Eye Hospital with biopsy-proven periocular lymphoma. Recorded evidence of prior thyroid gland abnormality or thyroid eye disease was sought and treatment details recorded, together with that of the subsequent periocular lymphoma. The calculated prevalence of thyroid orbitopathy in our patients with periocular lymphoma was compared with an estimate based upon published figures for a United Kingdom population. RESULTS: Of 369 patients with periocular lymphoma, 20 (5%) had a history of thyroid disease and adequate notes were available in 10 cases: All had autoimmune thyrotoxicosis between 11 and 27 years (median 17.5) before diagnosis of periocular lymphoma and 6/10 had thyroid orbitopathy-none receiving orbital radiotherapy for treatment of their thyroid eye disease. Using a calculated estimate for the UK prevalence of thyroid orbitopathy, the probability of even these six cases of ophthalmopathy among 369 patients with periocular lymphoma is very low (P=0.007). CONCLUSION: Compared with a population estimate, patients with periocular lymphoma had a significantly greater prevalence of preceding thyroid orbitopathy, with a median latency of 17 years. Thyroid orbitopathy possibly predisposes to later local lymphoma in a manner similar to the late emergence of lymphoma with other chronic inflammatory diseases-such as Sjögren's syndrome, Hashimoto's thyroiditis, coeliac disease, or Helicobactergastritis.

Adult↗
PubMed2003

Clinical features associated with survival of patients with lymphoma of the ocular adnexa.

PURPOSE: Although systemic or eyelid involvement by ocular adnexal lymphoma carries a worse prognosis, there have been few reports of the outcome in relation to clinical presentation. The outcome of malignant ocular adnexal lymphoma was, therefore, related to presenting clinical symptoms and signs. DESIGN AND METHODS: A retrospective, noncomparative case-note review of 326 patients treated in the Orbital Clinic at Moorfields Eye Hospital. The associations between presenting symptoms or signs and three outcome measures (v.i.) were assessed by univariate and multiple variable regression together with Kaplan-Meier analysis. MAIN OUTCOME MEASURES: (i) Presence of extra-orbital disease at the time of presentation; (ii) development of systemic lymphoma after new presentation with solely ocular adnexal disease; and (iii) death attributable to widespread lymphoma. RESULTS: Presentation with disseminated disease was rarer with over 1 year's ophthalmic symptoms (odds ratio (OR) 0.7; 95% CI 0.5-0.9) and much more frequent with bilateral adnexal disease (OR 5.8; 95% CI 3.0-11.2). With solely adnexal disease at presentation, subsequent extra-orbital lymphoma was more frequent and earlier with lacrimal gland disease (as compared to those without; hazard ratio (HR) 1.9; 95% CI 1.2-4.5) or with eyelid disease (compared to those without; HR 2.4; 95% CI 1.2-4.5), or with bilateral disease (compared to unilateral disease; HR 2.6; 95% CI 1.4-5.2). Prior or concurrent systemic disease was the most significant predictive factor for lymphoma-related death (HR 6.8; 95% CI 4.3-10.9), but tumour-related death was also commoner and earlier with bilateral disease (HR 2.4; 95% CI 1.4-4.0) or where a relative afferent papillary defect was present (HR 2.8; 95% CI 1.6-4.9). Similarly, the rate of tumour-related death was slightly less where symptoms had been present for more than a year (HR 0.8; 95% CI 0.7-1.0) and slightly greater in the elderly (HR 1.03; 95% CI 1.01-1.05). Conjunctival lymphoma had the lowest rate of extra-orbital spread and lymphoma-related death, the rate of these two events being sequentially greater for patients with predominantly deep orbital lymphoma, lacrimal gland lymphoma, or eyelid lymphoma. CONCLUSION: These data suggest that presenting symptoms and signs of patients with ocular adnexal lymphoma are significantly associated with the risk of systemic disease at orbital presentation, the rate of subsequent spread, and the rate of lymphoma-related death.

Adolescent↗
PubMed2003

Management of lacrimal sac tumours.

PURPOSE: To report a series of 15 primary lacrimal sac tumours and present an algorithm in managing this rare condition. DESIGN: Noncomparative interventional case series. METHODS: A retrospective review of the clinical, radiological, and pathological records of 15 patients with primary lacrimal sac tumours. Main outcome measures Histologic evaluation and clinical follow-up, including tumour clearance and recurrence, were assessed. RESULTS: Of the patients, 11 were female and the median age at presentation for the whole group was 59 years (range 22-94 years). The commonest tumour was non-Hodgkins B-cell lymphoma (five cases), followed by two cases each of squamous cell carcinoma and transitional cell carcinoma, one case of benign transitional papilloma, haemangiopericytoma, adenoid cystic carcinoma, mucoepidermoid carcinoma, mixed (squamous/transitional) carcinoma, and a highly malignant undifferentiated tumour. Treatment modalities included surgery, radiotherapy and chemotherapy and, with a median follow-up of 30 months (range 2 months to 17 years), two patients had died from metastatic disease but nine patients remained without evidence of recurrent tumour. CONCLUSIONS: Primary lacrimal sac tumours are extremely rare, require long-term follow-up for recurrence and metastasis, and can be fatal.

Adult↗
PubMed2002

Primary orbital melanoma masquerading as vascular anomalies.

PURPOSE: To review two cases of primary orbital melanoma presenting like orbital vascular anomalies. METHODS: Retrospective review of clinical presentation, treatment, radiology and pathology for two patients under the care of the Orbital Clinic at Moorfields Eye Hospital. RESULTS: Both lesions presented with the appearance and behaviour of vascular anomalies. In one case, a spindle cell melanoma appeared to be a low flow vascular anomaly with a loculated secondary haemorrhage and, in the other case, a melanoma of soft parts was considered to be an arteriovenous malformation and responded partially to embolisation. CONCLUSION: Primary malignant melanoma may present as a secondary vascular lesion of the orbit and this very rare tumour should be considered in the differential diagnosis of any vascular anomaly.

Adult↗
PubMed2002

Clinical, radiological and pathological examination of periocular dermoid cysts: evidence of inflammation from an early age.

INTRODUCTION: Periocular dermoid cysts are common and leakage of the lipid or keratin contents leads to an inflammation-often asymptomatic-around the cyst, which may cause adherence of the dermoid cyst to neighbouring structures. PURPOSE: To investigate the frequency of clinical and radiological signs of inflammation with periocular dermoid cysts, to relate this to the histopathological examination of the excised specimens, and to assess whether the degree of inflammation is related to age at presentation. PATIENTS AND METHODS: A retrospective non-comparative series of 124 patients with periocular dermoid cysts that had undergone imaging. Case-notes were reviewed for clinical and histopathological details and there was independent review of the radiological imaging. RESULTS: Surgery was undertaken at between 1 and 66 years of age, most patients being under 10 years, and the duration of symptoms varied from 4 weeks to 30 years. Symptoms of inflammation-mainly intermittent lid swelling with localised redness and pain-occurred in all age groups, the proportion being greatest in the fourth decade. Clinical signs of inflammation at the time of clinic visit were relatively few, although 8% had some localised erythema and 7% had tenderness at the site of lesion. In more than two-thirds of the excised cysts, pathological examination demonstrated various degrees of chronic inflammation, even in those cysts removed before the age of 5 years. CONCLUSION: Even if the patient does not have symptoms or signs of inflammation, most periocular dermoid cysts show histological evidence of inflammation due to leakage of the lipid and keratin contents from the cyst, the incidence being similar at all ages.

Adolescent↗
PubMed2001

Two unusual osteogenic orbital tumors: presumed parosteal osteosarcomas of the orbit.

OBJECTIVE: To report two cases of suspected parosteal osteosarcoma of the orbit, with dedifferentiation into a high-grade liposarcoma occurring in one patient. DESIGN: Two retrospective case reports. METHODS: The clinical, radiologic, and pathologic records of two patients with suspected orbital parosteal osteosarcoma were retrospectively reviewed. MAIN OUTCOME MEASURES: Histologic evaluation and clinical follow-up were measured. RESULTS: The first patient was a 47-year-old male presenting with a 5-month history of painless right lower lid swelling; excision biopsy suggested a well-differentiated parosteal osteosarcoma of the orbital floor, which recurred 3 years later. Six months after excision of the recurrence, the mass demonstrated accelerated growth, and a lid-sparing exenteration was performed; histologic examination showed a high-grade liposarcoma. The patient remains disease-free at 4 years. The second patient, a 40-year-old male, presented with an 8-year history of proptosis and a right superotemporal orbital mass. The mass was excised completely at lateral orbitotomy; histologic examination suggested a well-differentiated parosteal osteosarcoma. The patient remains well 9 months postoperatively. CONCLUSIONS: Parosteal osteosarcoma is an uncommon tumor, usually affecting long bones, that is extremely rare in the orbit. It is a low-grade sarcoma that tends to recur locally after excision but has a favorable prognosis. Dedifferentiation into a high-grade sarcoma occasionally occurs in parosteal osteosarcoma, but transformation into liposarcoma does not seem to have been previously reported. It is important to recognize dedifferentiated parosteal osteosarcoma, because the prognosis is poor, and radical treatment may be required.

Adult↗
PubMed2001

Pediatric dacryocystorhinostomy for nasolacrimal duct obstruction.

OBJECTIVE: To determine the outcome of pediatric dacryocystorhinostomy (DCR) for large mucoceles or for primary nasolacrimal duct obstruction unresponsive to multiple probings. DESIGN: Retrospective noncomparative case series. PARTICIPANTS: One hundred thirty-four external dacryocystorhinostomies were performed in 121 children. METHODS: Clinical case notes were reviewed for a series of cases operated on at Moorfields Eye Hospital by specialist lacrimal surgeons between 1987 and 1999. MAIN OUTCOME MEASURES: Postoperative relief of presenting symptoms and signs and complications. RESULTS: Fifty-nine percent of admissions (75 of 127) were day cases, and the other 52 admissions were inpatient. Simultaneous bilateral surgery was performed in 7 of 121 (6%) children, all but one having day case admission, and sequential bilateral surgery in 6 of 121 (5%) cases. Silicone intubation was performed in 20% of operations, these generally being early in the series. Three children had Down syndrome, five had craniofacial anomalies, and two had systemic disorders. Mild postoperative cellulitis occurred in three cases, all of which settled without complication after systemic antibiotic therapy, and there was one case of suture granuloma. There were no cases of immediate postoperative complication in either the day case or the inpatient groups. Complete cure of symptoms was achieved in 96% and an improvement of symptoms (with mild persistence of epiphora under challenge) in five cases (4%). CONCLUSION: For surgeons experienced in pediatric lacrimal surgery, external DCR with sutured mucosal flaps can be accomplished through an 8-mm incision with no surface sutures and minimal scarring. Symptoms are improved in all cases and complete cure achieved in 96%, with no immediate postoperative complications and only few (3%) short-term complications. The surgery is amenable to day case management, without significant morbidity, and may be performed as a simultaneous bilateral procedure.

Adolescent↗